| NPI | 1235661521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 021324) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: PR 021324) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2026-05-21 |